Cartas al editor
What happens to patients who leave without being seen in an emergency department?
¿Qué pasa con los pacientes que se van sin ser vistos en un servicio de urgencias?
Received: 05 May 2019
Revised document received: 06 May 2019
Accepted: 07 May 2019
Patients who leave without being seen from the emergency services represent a risk, because some of them may have diseases that can eventually lead to major adverse events, such as the need to revise, progression of diseases, hospitalization, emergency surgeries or death; that is why it is suggested to the emergency services to carry out an indicator of these events, differentiating the patients leaving emergency departments after being cared for and wish to leave the service against the recommendation by health professionals1,2.
There is little known about this phenomenon at the local level. One of the reasons may be that, currently, it is not an indicator that is routinely required in evaluations by local and national health authorities.
In the emergency service of Instituto Neurológico de Colombia, a retrospective analysis was conducted, concerning the phenomenon of patients who leave the service without being formally seen by a medical professional; the subjects were identified through those who registered administratively to be attended and who, at the time of calling for their respective triage classification, were not in the service and those who were classified, but at the time of being called for medical attention were not in the service. Once identified, they verified with their insurer that they were not in urgent medical attention at other institutions; patients were called to confirm their state of health and the reasons for their abandonment.
During March through May 2018, 12.680 subjects consulted to the service; of these, 199 (1.5%) discontinued service: 81 (0.63%) before triage and 111 (0.87%) following triage. In terms of complications derived from their abandonment, 2 patients required hospitalization without mortality. As for the causes, the main reasons for the abandonment were: perception of delay in care, administrative barriers, and resolution of symptoms in the waiting room.
The literature suggests that the percentage of patients who leave the emergency department unattended ranges between 0 to 2%,2,4; most of these individuals are young adults with mainly musculoskeletal complaints with low probability of progression and complications. They are patients who perceive themselves as without risk, which means that they do not become complicated in terms of disease progression or adverse outcomes5.
Our data suggest that local behavior is like that reported internationally.
The authors declare an absence of conflicts of interest.